The incidence of pressure ulcers in hospitalized patients is widely recognized; less recognized is the incidence and cost of treatment of pressure ulcers resulting from surgery. Research estimates indicate that an average of 12 percent of surgical patients suffer some degree of skin pressure injury. In 1998, Beckrich and Aronovitch reported, "operating room acquired pressure ulcers represent a direct cost to the US healthcare system of $750 million to $1.5 billion annually". The proposed work will raise the standard of care by developing a surgical support surface with improved pressure management and patient stability characteristics. Our device utilizes an innovative three layer construct design with novel sensing system to provide advanced pressure management and stability. These aspects are anticipated to decrease the incidence of surgically induced pressure ulcers. Our preliminary data demonstrates a marked decrease (50%) in contact pressure compared to a standard surface. The current project will focus on the optimization of the air cell grid design by means of a large displacement finite element analysis. Prototypes of the support surface constructs will be fabricated and tested to establish the performance for pressure management (Xsensor(TM) system), patient stability (video analysis system) and radiolucency (equivalent aluminum thickness). PROPOSED COMMERCIAL APPLICATIONS: The primary focus of this work is a product that addresses the mechanical factors leading to pressure ulcers from the operating room environment. Over 40 million surgical procedures are performed annually in the US, of which a significant percentage involves a surgical population at risk of developing pressure ulcers (diabetic, impaired circulation, immobile, elderly) or a duration that would present an ulcer threat to a "healthy" patient. An approximate market size can be based on the 28,000 operating tables in US hospitals. Current "high-tech" support surfaces can cost nearly $10,000. Our proposed device can provide similar if not equivalent pressure management characteristics at approximately one quarter of the price. We believe the proposed support technology is also applicable to a number of other significant markets, including ambulatory surgery and emergency medicine, where comfort and stability are important patient issues. Extended healthcare, including nursing homes, home and hospice care, rehabilitation hospitals, intensive care units, is another extensive market for pressure ulcer prevention.